Provider Demographics
NPI:1316193253
Name:KOCH, MEAGAN CHAILLE (LCMHCA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:CHAILLE
Last Name:KOCH
Suffix:
Gender:F
Credentials:LCMHCA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 AMERICAN LEGION RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5654
Mailing Address - Country:US
Mailing Address - Phone:757-686-8018
Mailing Address - Fax:
Practice Address - Street 1:3806 PEACHTREE AVE STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6752
Practice Address - Country:US
Practice Address - Phone:910-251-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004275101YM0800X
FLMH9173101YM0800X
NCA16559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health